title: Vinorelbine, paclitaxel, etoposide, cisplatin, and cytarabine (VTEPA) is an effective second salvage therapy for relapsed/refractory Hodgkin lymphoma.
abstract: BACKGROUND
  For Hodgkin lymphoma (HL) patients with refractory or relapsed (R/R) disease after primary therapy, the standard of care is a salvage regimen followed by autologous stem cell transplant (ASCT). However, patients who fail to respond to a salvage regimen have limited options. Our phase I study of cytarabine combined with fixed doses of vinorelbine, paclitaxel, etoposide, and cisplatin (VTEPA) for patients with R/R lymphoma showed an overall response rate (ORR) of 33%.
  
  
  METHODS
  To further examine the effectiveness of VTEPA, we conducted a retrospective review of 30 cases of R/R HL who received a salvage combination of VTEPA.
  
  
  RESULTS
  This population included 15 men (50%), 18 stage III/IV (60%), and 14 with an International Prognostic Score ≥3 (47%). The median number of previous regimens was 2 (range, 1-4), 19 patients (63%) received previous salvage therapy with ifosfamide, carboplatin, and etoposide. Twenty-seven patients were evaluable for response. The most common Grade 3/4 toxicities were pancytopenia (19 patients, 97%), nausea/vomiting (17, 57%), fatigue (14, 47%), and infection (6, 20%). Of the 27 patients evaluable for response, the ORR was 70% (7 complete response and 12 partial response). Twenty patients (66%) went on to ASCT and 1 patient underwent allogeneic transplant. With a median follow-up of 32 months, the median progression-free survival (PFS) and overall survival (OS) in patients who received transplantation after VTEPA were 28 and 38 months, respectively.
  
  
  CONCLUSIONS
  Treatment with VTEPA for R/R HL is feasible with manageable side effects. With a high ORR, the PFS and OS for this group of patients suggest that VTEPA is a promising regimen for HL patients in whom previous lines of therapy have failed.
authors.affiliation: Winship Cancer Institute, Hematology and Medical Oncology, Emory University, School of Medicine, Atlanta, GA.
authors.forename: Rajni
authors.initials: R
authors.lastname: Sinha
authors.forename: Pareen J
authors.initials: PJ
authors.lastname: Shenoy
authors.forename: Nassoma
authors.initials: N
authors.lastname: King
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Lechowicz
authors.forename: Kevin
authors.initials: K
authors.lastname: Bumpers
authors.forename: Donald
authors.initials: D
authors.lastname: Hutcherson
authors.forename: Martha
authors.initials: M
authors.lastname: Arellano
authors.forename: Amelia
authors.initials: A
authors.lastname: Langston
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kaufman
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Heffner
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.forename: Ajay
authors.initials: A
authors.lastname: Nooka
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D055815:Young Adult
chemical_list: D003561:Cytarabine; D014747:Vinblastine; D005047:Etoposide; D017239:Paclitaxel; D002945:Cisplatin; D000077235:Vinorelbine
keywords: Chemotherapy; Hematopoietic stem cell transplantation; Mobilization; Treatment